Friday, September 16, 2011

Is the mandate really the only answer?

Offer me a choice between a corporatist
or socialist government health care system and I'll gladly take the
latter. Within the confines of acceptable Washington discourse, we're
not debating whether the state should intervene in the health care
market and whether it that will cause more harm than good, but what
form that massive intervention should take; should it be marginally
more beneficial to the poor or to corporations. And though far from
my ideal though the current system may be, I'll take it with the few
scraps we call a safety net rather than without.

The persons that line the road to my
anarchist paradise aren't those living on the margins of society,
after all, but the corporations largely responsible for the stagnant
wages that put them there.

Unfortunately, the health care
reform bill signed into law by President Obama doesn't strike me as a
marginal improvement of an awful status quo, but rather a significant
step toward further entrenching the corporate health care model
that's created the awful situation the reform was purported to
address. For that reason, I'm not buying our old friend Matt
Yglesias' claim that, in order to deal with a hypothetical
“30-year-old man with a decent job [who] decides to go without
health insurance” and ends up falling into a coma, the only real option
available to us is to mandate that he have purchased private
health insurance, as required by
the latest health care reform.

Yglesias
arrives at this conclusion by labeling discussion of why the costs of the status quo might force
a 30-year-old man with a good job to forgo any sort of health
coverage side-stepping "nonsense." Indeed,
Yglesias rather ludicrously dismisses the question of cost with the
headline to his piece: “Should
We Let People Die If Unrelated Government Policies Tend To Drive Up
The Costs Of Health Care?” When you call any health care reform other than
an individual mandate “unrelated,” it's no wonder the only answer
you're left with is the individual mandate.

But
though he's dismissive and myopic, seeking to limit the debate over
health care to WhatDoWeDoAboutJoeComa?, the costs
of the U.S. health care system are hugely relevant. And huge.

Pharmaceutical
giants, which spend the majority of their earnings on advertisements
for penis pills, not research on cures for cancer, reap monopoly
profits thanks to the fact the U.S. government grants them the
exclusive right, via patents, to combine chemicals in a certain way,
prohibiting cheaper competition and dramatically driving up the cost
of medicine not just for Americans, but for countries that sign “free
trade” agreements with the U.S. mandating they respect said
“intellectual property.” As economist Dean Baker notes in his new
(and free) book, The
End of Loser Liberalism:

“[The U.S.] will spend close to
$300 billion in 2011 on prescription drugs. In the absence of
government- enforced patent monopolies, the same drugs would cost
around $30 billion, an amount that implies a transfer to
the pharmaceutical industry of close to $270 billion a year, or about
1.8 percent of gross domestic product. ”

In other words,
Americans are spending ten times as much as they need to for medicine
because of government-enforced monopolies. And the same rent-seeking
costs are included in the price of medical devices and other
life-saving equipment, helping explain why someone would need
insurance in the first place. Baker also notes that the costs of
visiting a doctor are inflated, not just by licensing, but by
restrictions on foreign doctors coming into the U.S. – restrictions
that were sought by doctors' groups to, of course, increase the cost
of visiting doctors. Medical costs are as a consequence driven up for citizens at the same time profits skyrocket for corporations, creating a situation where many people can't afford to benefit from the Greatest Health Care System in the World.

Here's Yglesias'
reaction to that line of argument:

“The government has a lot of
policies. Many of them are bad ones. Many of those policies increase
the price of this or that. Then over and above that, situations occur
that require responses. For example, an uninsured person may be
struck by some terrible misfortune and require medical attention. At
which point we can let him die, or we can pay for his treatment.”

The
thing is, because I'm nit-picky: The original question wasn't whether
we “let him die” or “pay for his treatment,” but rather who
should pay for said treatment. And even accepting the premise that
we can't do away with every bad, corporate profit-boosting
government policy right now so let's focus on this one particular
narrow question, it doesn't follow that,
once we concede we should do something, “we now have a strong prima
facie case for some kind of mandatory minimum level of health
insurance coverage,” by which Yglesias means mandating that every
American purchase private health insurance.

A national single-payer system, while
not my preference, is one obvious alternative for addressing our
hypothetical coma victim that, by contrast to the insurance mandate,
doesn't increase the grip private insurance companies have over the
U.S. health care system. Or the federal government could – get this
– devolve power and allow states and local governments to
experiment with different approaches to providing health care for
their constituents, which would at least allow for variation,
diminish the risk of corporate capture and, who knows, maybe even
allow for the rise of truly consensual, community-based approaches to
health care, which entrenching the corporate system via a national
mandate most certainly does not.

Not only is the
mandate not the best option, even within the confines of acceptable
Beltway discourse, it only adds yet another coercive element to U.S.
society that directly benefits private corporations, a practice I
think we ought to be minimizing, not increasing. It also burdens
every not-a-coma-victim with costs that may not make sense for them,
or even for most people who are, again, not coma victims; in many
cases, the money spent on insurance might be better spent on
healthier food, education or whatever the hell a member of a free
society chooses. The mandate also prevents the rise of alternatives
to corporate-provided health care; under Obama's health care reform,
you literally have no choice but to go the corporate health care
route, further cementing the employer-coverage link – good luck
quitting your dead-end job if you want to ever get a check-up again –
while securing the insurance industry a legally mandated customer
base.

Anyone who has
dealt with a cable company knows what customer service is like when a
corporation, or in this case an oligarchy, knows you have no choice.
What Yglesias proposes as a life raft to our poor 30-year-old in a
coma ends up looking more like an anchor to the rest of us.

Further,
Yglesias' intentionally constraining argument that we ought to put
aside why the health care system is the way it is and just accept the
status quo with the band-aid of a mandate is similar in spirit to a
lot of the arguments I remember hearing in the aftermath of 9/11. No,
no, let's not consider how U.S. foreign policy creates enemies around
the world by killing loads of innocent people, in turn causing
blowback that kills loads more. No, let's just discuss who we kill
next. This is a post-9/11
world, thank you. And since U.S. foreign policy isn't going to
radically change, your comprehensive, holistic solutions to
terrorism just won't do, sowho do we bomb now?

Finally, I can't help but ask: whatever
happened to vision? Why – and this is a rhetorical question – are
liberals like Yglesias so reflexively dismissive of discussing
broader, radical reforms to the system? Since when did milquetoast
reformism become the rallying cry of the Left? I know many leftists still value decentralism and community-based solutions to problems such as the health care crisis -- they're key planks of the Green Party's platform -- but if you listened to the Ygelsiases and Ezra Kleins of the world, you'd think only a Tea Partier could object to a centralized solution that mandates the purchase of a private company's product.

33 comments:

You're leaving two huge things out of this argument. One, the fact that Yglesias and others are addressing the health care we managed to get passed, not what progressives/lefties wanted; and two, that the mandate will be almost entirely covered by subsidies for virtually everyone. Do I want this lame health care "reform" that does little but line corporations' pockets? Hell no. I wanted single-payer, something like Germany, or Medicare for everyone. But, of course, Obama capitulated before the fight even began, and so we're left with this crap.

But at this point, it is actually better than nothing. It requires insurance companies to do away with the preexisting conditions bullshit, which is crucial, among other things. And it will actually provide me with the first stable health insurance I've had in a decade, which I will not have to pay for due to the subsidy I will receive. You're young and healthy. What might be ahead isn't looming over you yet. But for those of us with recurring, serious, or terminal health conditions, this may be life-saving.

As to your ideas regarding communities becoming responsible for the care of its citizens, that time passed over one hundred years ago. If you leave health care up to localities, do you honestly think we're going to get more than "let him die" rhetoric from many of them? I can easily foresee local choice devolving into being able to have a state-supported system in places like Massachusetts and Vermont, and zero in Kansas and Montana, something exacerbating the polarities of this country even more. When we left things like segregation and interracial marriage up to communities, it took federal intervention to end them. If the federal government hadn't stepped in to stop segregation, I am quite sure that we would still have it in many areas of the South. Look at how radicalized the Teabaggers are, how big movements like militias and sovereign citizens have become. You want to leave this to the vagaries of human nature? You're kidding, right? Health care, like the highway system, is something that requires administration by something that can handle such a huge assignment, something not driven by profit - and the only thing that qualifies with that is the federal government.

Does the idea of enriching corporations and entrenching their power make me sick? Yes. Do I hate the idea of Obamacare? Absolutely. Do I have a choice? No, I don't. I would rather have this than nothing. And hopefully down the line, this health care "reform" will be truly reformed.

And you know, you don't have to bring in US foreign policy to everything. It's not an apt analogy here, to be sure. And argumentum ad nauseam gets very tiresome, especially when you're preaching to the choir.

@nSquib – the ACA is a Trojan Horse. Ezra Klein openly advocates using the ACA to get rid of Medicare and Medicaid. According to Klein, both Medicare and Medicaid should be rolled into the ACA, forcing people who benefit from these programs to instead buy private health insurance through the ACA exchanges.

“I know that Yuval Levin has many criticisms of the Affordable Care Act. But much of [his essay] reads like a straightforward description of the law… ‘Let people be active consumers’? That’s exactly what the exchanges are meant to accomplish. The major difference [between Levin’s proposal and the ACA] is that the Affordable Care Act doesn’t roll Medicare and Medicaid into the exchanges, though that’s something that many of the law’s advocates — myself included — would eventually like to see happen…

“One of the theme [sic] of this blog is that if you actually look at the policy proposals of the two parties, Democrats and Republicans support many of the same ideas in theory, even thought the forces of partisanship and incentives of elections make it impossible for them to support the same ideas in practice. So I don’t expect Levin to be teaming up with the Center for American Progress anytime soon. But here, in an essay published in a conservative journal and aimed at a conservative readership, it certainly seems as if he could.”

I addressed the argument Yglesias made, which is that someone lacking health insurance who incurs large costs as a result of a traumatic incident is a “prima facie” argument for an individual insurance mandate. I disagree. I think we have better options and that we shouldn't just passively, aw shucks, accept the ones put forward by a political class that's financed by, and serves, the very corporate actors responsible for the incredible cost of health care in America.

As to your ideas regarding communities becoming responsible for the care of its citizens, that time passed over one hundred years ago.

This, frankly, isn't an argument. This is responding to an argument that the state is too large and powerful by saying, “The state is large and powerful, Q.E.D.” The modern nation-state is a rather recent human development and one that brought us the bloodiest century in recorded history. Just because it exists now does not mean it always will or that the status quo is Progress. And while I'll concede the federal government's role in helping end segregation – only after a mass civil rights movement forced it to bend to public will – I'll also point out that it was that federal government which upheld the institution of slavery and which made anti-slavery states in the North complicit in that institution with the Fugitive Slave Act. The federal government's war on drugs has also helped create the largest prison population in world history – 2.3 million souls – with more African-Americans incarcerated than were ever enslaved.

Progress?

Your comment also displays a remarkable amount of condescension and fear toward the very people I was always told the government is supposed to represent; why, if coastal elites weren't running everything, you posit, the Midwest would simply turn into a backwater of pregnant 15 year olds popping out babies to join the local white supremacist movement. Granted, some regions of the country are reactionary, and I don't discount the possibility they could impose reactionary policies – policies, mind you, that people in those states would have more power to shape than they do now, impotently signing online petitions demanding Congress or the White House do X, Y or Z. But was George W. Bush really so long ago? Aren't liberals supposed to be scared of Rick Perry? You're afraid of reactionaries taking over Kansas; I'm worried about them taking over the country, where they can do a helluva lot more damage.

A 1910 NY Times editorial condemning the fraternal societies and lodge practices that supplied inexpensive medical care (like those described in Long's piece) as "evil", "hampering medical progress" and of "depriving a large number of worthy and capable practitioners of the fruits of dilligence".

You want to leave this to the vagaries of human nature? You're kidding, right? Health care, like the highway system, is something that requires administration by something that can handle such a huge assignment, something not driven by profit - and the only thing that qualifies with that is the federal government.

Humans: they can't be trusted to take care of each other without coercion, the brutes, but they can be trusted with massive power and the tools of coercion it entails. As for the “vagaries of human nature,” do you think states are immune from the less desirable human traits? You evidently have a very poor opinion of your fellow Americans, and yet you want them to be able to vote and implement coercive policies over a nation of 300 million? States, like any other institution, are composed of fallible human beings who, if history has taught us anything, don't really do so well when they possess massive amounts of power. And amassing power in one place, Washington, DC, is a recipe for regulatory capture by pharmaceutical companies and insurance giants, which is exactly what we saw with health care reform. You don't have to be an anarchist to see the wisdom in a least devolving power to states and local governments that, while prone to the same corruption albeit on a smaller scale, are more flexible and responsible to their constituents' needs. And your comment that we're stuck with either profit-making corporations or the government that guarantees them monopoly profits through mandates and patents is . . . a false dichotomy (*balloons fall*).

I'm proposing local, consensual socialism to deal with health care. Worker-owned businesses working with local health care professionals to provide their own care. I'm proposing allowing doctors to form non-profit coverage plans. I'm proposing eliminating patent monopolies and allowing nurses and physicians to set up community health clinics and non-profit hospitals without fear of being shut down by politicians beholden to the insurance industry. I'm not suggesting this will happen overnight or that services currently provided by the state ought to be eliminated tomorrow. It will involve people such as yourself rejecting apathy and the notion that we can only depend on politicians and elections for change in favor of direction action and community organizing. But that's the direction I'd like to see the U.S. health care system go in; Obamacare sends us in the opposite, corporate direction.

nSquib:And you know, you don't have to bring in US foreign policy to everything. It's not an apt analogy here, to be sure. And argumentum ad nauseam gets very tiresome, especially when you're preaching to the choir.

I'm preaching to whoever reads this blog. Have you read the comments at a liberal blog lately? But since you brought it up, let's extend the argument about why foreign policy is relevant: you cast the federal government and centralized power as a force for progressive change, as the only institution that can address the health care crisis without reaping a profit (never mind that said government has consciously crafted a health care market that maximizes corporate profit). Well, it's also the same institution that has literally killed millions upon millions of poor people from Vietnam to Iraq. It's the same institution that, under a "progressive," has murdered thousands of innocent Pakistani, Yemeni and Somali mothers, fathers and children. It's the same institution that tries to limit poor people around the globe's access to generic, life-saving medicine. That fact can't be divorced from the call to increase the power of politicians in Washington. Indeed, it's a consequence of that centralization, one that I think greatly outweighs any perceived benefits.

Sure, state and local governments can be evil. You don't have to convince me of that. But they're also easier to pressure than, say, Congress or the White House. And as a general rule, they don't start world wars or invade and occupy places on the other side of the globe.

For those touting/reluctantly accepting the mandate through the lens of steely-eyed realism, there's one big fucking problem: multiple courts don't think the damn thing's constitutional. You may say it's better than nothing, but there's a very real possibility that legal smackdowns will make it nothing anyway. That alone makes Single-Payer a more pragmatic political reality, snarky beltway logic notwithstanding.

This is the second time today I've seen someone posit a not-an-argument by incorrectly using "human nature" when they really meant "social mores inherent to an advanced corporate capitalist imperial power".

I very much agree with your sentiment, Charles. The Obama/Romney health insurance plan is immensely disappointing. It strengthens the power of private health insurance corporations, and it may make a single-payer system more difficult to implement down the road (though Vermont is about the implement a very promising single-payer system which may be the first of others at the state level). So I was completely disgusted by the bill, and the idea that this was some kind of victory for the left is a sick joke. Also, if it's the best that the Democrats can do with huge majorities in both houses and the presidency, then I think it's well past time to abandon the Dems entirely.

However, one may also acknowledge that the subsidies and the regulations on the health insurance industry that were included in the plan are likely to improve many people's lives and generally make things a little better than they were before. It's not a contradiction to say that the bill was a vile bit of corporate treachery, massively disappointing and generally nauseating to think about, but it's still a slight improvement over the system it was replacing.

Not only is the mandate not the best option, even within the confines of acceptable Beltway discourse, it only adds yet another coercive element to U.S. society that directly benefits private corporations

Nail on the head.

Coercive element is it exactly. A hierarchichal system works on the premise of coercion, a physical threat by proxy through deprivation of income, which in turn serves as the means to satisfy physical needs of sustenance and secure shelter, met with yielding submission on down the hierarchical chain. The more coercion built into the system, the greater the threat that is needed to sustain its dynamics of material hierarchy. The level of threat needed does not go up because of a low bottom, but is directly related to the distance between the bottom and the top; in other words, the poor are acting under pressure by the accumulated coercive mechanisms in the system, such as this one, into giving up a lot more as the ceiling gets higher above them because that ceiling is rising on the material they are giving up; generally people understand that no one, no matter how talented they are, is actually worth, in whatever way or function you personally define human worth, that much more than the least valuable person. If person A and person B were your sibling, and they fit any number of descriptors of humanity, you would agree that in spite of minor differences that only make sense as value judgement in very limited contexts, such as economic utility, they were inherently worth about as much as one another as people to you. Even in specific contexts, such as economic utility, it is still hard to see how much any of us actually contributes to society, but the spread does not seem like it could be very large. As contributors, its hard to see how a blacksmith and a banker differ in actual value added to society on a material basis, capitalists (and bankers) say that it is whatever the market will bear, but that logic and system of valuation says that some people make hundreds of millions of wealth all by themselves every year, and the vast majority make a piddling few thousand, fractions of a percent of someone else. So this seems suspect, and the greater that suspicion, the less infallible the overall system that gives us such a valuation becomes. This gets to starting to question things like capitalism, or democracy. And then, the system needs more coercion as disillusion rises and consent withdrawn.

And you know, you don't have to bring in US foreign policy to everything. It's not an apt analogy here, to be sure. And argumentum ad nauseam gets very tiresome, especially when you're preaching to the choir.

Oh geez, sorry, didn't realize you were tired of hearing about all the people we've murdered/are still being murdered by us. Man that must really be a pain in the ass for you to keep having to hear about that death and slaughter done in your name. All those families missing fathers/mothers/brothers/sisters/uncles/aunts/arms/legs/etc... really need to get over that shit already, amirite?

I mean who can't trust a machine that actually thrives on death to take care of our health?

“Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy…

“[E]mployers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.”

Back in July, Krugman slammed Obama for being willing to raise the Medicare eligibility age, which would shift people out of Medicare and “into the inefficient, parasitic world of private insurance.” Krugman supports the ACA, but he called it a “Rube Goldberg scheme” that should not supplant Medicare coverage.

Digby directly responded to Ezra Klein’s assertion that “it'd be natural to eventually migrate Medicaid and Medicare into the [ACA] system.” Digby wrote:

“I certainly do not want elderly people thrust into a health care system where they have to navigate profit making insurance companies, no matter how well ‘it works’ on a macro level or how much ‘support’ they get for their premiums.(And there is ample reason to doubt that it will work for such a sick population anyway.) It honestly never occurred to me that the administration and the promoters of this health care reform were actually designing it with that in mind.”

@Karl Franz: you can go fuck yourself. Try going without health insurance for twenty years with a pre-existing condition and see how you feel about getting anything that might begin to help you. I already stated that I hate most of this reform and what I'd prefer, but you chose to ignore that to be an asshole. Good on you for your substantive reply.

@Charles Davis: Yglesias said "we now have a strong prima facie case for some kind of mandatory minimum level of health insurance coverage." He didn't necessarily mean Obamacare or the mandate as it works under that. A mandate can mean universal taxation. He also didn't explicitly support Obamacare in that post. For you to discuss him as if he is endorsing Obamacare and by extension insurance companies is indeed a straw man. I don't think we should passively aw shucks accept anything either, no matter how much you'd love to portray me that way.

You didn't go into detail about what you meant by communities taking care of their own in your original post, so what was I left with to answer but a general idea of people taking care of people, which I think everyone can see from the state of affairs in our country today is simply not going to happen.

Your conflating what I was saying about the federal government with slavery (I mean, really?) and the war on drugs is, again, not apt. The progress made by the federal government in civil rights of course can be countered by the regression we saw under Reagan, who started the war on drugs. Fortunately, at the very least, many of the worst effects of the war on drugs are beginning to be addressed and rolled back, like mandatory minimums and the like. Which, again, is better than nothing. You can't counter every semi-positive comment about the federal government with "ahh WAR ON DRUGS" AND "ILLEGAL WARS R BAD!!!" We already know that. Counter such comments as to why the federal government would not be able to run a national health insurance plan (not the one we have currently). Then you might be on the right track.

@charles davis cont.: To simply call out my statement and say that it "isn't an argument" is false. It is a perfectly reasonable argument if you look at the draconian legislation that's come out of the states in the last year or two under the Teabaggers. As it stands now, Virginia will probably not be able to offer any abortions unless the current law is overturned. Similar laws are being challenged in Kansas, South Dakota, etc. What I displayed with my comment is hardly "condescension"; it's simple fact, unless of course, you don't care about the rights of women being stripped away, which if you're a Ron Paul apologist, you don't. But, sure, I am fearful of what will happen if the federal government cannot pull states into compliance with basic constitutional rights. We are already seeing it every single day. You know that.

"why, if coastal elites weren't running everything, you posit, the Midwest would simply turn into a backwater of pregnant 15 year olds popping out babies to join the local white supremacist movement." Don't put words in my mouth and please address the arguments I've actually made. You have a remarkable tendency to jump to the most extreme conclusions about things and overexaggerate what you think people mean. You speak as if I am unaware of the power of corporations et al in Washington or if I'm being naive about the situation. It is you who is revealing naivete here. I've actually worked in Congress and what I saw sickened me so much I didn't pursue a career there as I'd been planning. What I've said does not glorify the federal government. It merely acknowledges that the checks and balances system we have in place has been a place where reactionary policies put in place by states have been checked (and where it has failed as well of course). The supremacy of the federal government is the reason we have a Constitution instead of Articles of Confederation. What I was discussing was not so much the federal government as a place of consolidated power, but as an apparatus big enough and not motivated by profit, which would be an appropriate apparatus to run a national health care system, as we see in many other Western countries.

"And your comment that we're stuck with either profit-making corporations or the government that guarantees them monopoly profits through mandates and patents is . . . a false dichotomy (*balloons fall*)." First, do you have to be such a dick? Second, that's a straw man. I never said that we either have corporations or a government that guarantees them a monopoly and for you to draw what I said that way is incredibly disingenuous and self-serving. I said that a federal government is an appropriate apparatus to host a health care system, which I think they should instead of private companies. Not that it should be feeding corporations or using corporations to implement their system, which is what they are doing now and with which I've registered my dissatisfaction many times. So…hardly the "false dichotomy" you're so eager to promote.

@Charles Davis cont.: "It will involve people such as yourself rejecting apathy and the notion that we can only depend on politicians and elections for change in favor of direction action and community organizing. But that's the direction I'd like to see the U.S. health care system go in; Obamacare sends us in the opposite, corporate direction." People "such as yourself rejecting apathy"? And I feel we can "only depend on politicians and elections for change"? LOL, bitch please. So you've decided to take the fact that I wanted to say what's going on right now is better than nothing at all although I don't endorse the "reform" that's been employed and I hate Obama for capitulating and turn it into me being apathetic and an apologist? Come off it. You know very little about me, what I believe, and what I've done despite the fact that I've followed you on Twitter, which should imply some endorsement and sympathy for your political views. So I'm not allowed to say that Obamacare is better than nothing without being charged as a full-blown supporter who embraces everything it's about? That's patently absurd, and it's not what I've said. This is very much akin to "if you're not with me, you're against me," and that's fucking wrong, so wrong. I don't think I should have to preface every blog post I make with an extended litany of my complex political beliefs as a defense. I shouldn't have to give you a CV of every anti-war or other protests I've been in, which I've been doing since you were a very small child. I was arguing with my teachers about Reagan's illegal wars the year you were born. You should simply actually address the words I've written without extrapolating them into this nebulous Obama apologist argument and arguing against that instead, which is fallacious argumentation.

As to my comments about your repeated comments about US foreign policy - I was talking about your Twitter feed more than this blog (I make it a practice to try to avoid all political blogs). Every other tweet you post screams about ILLEGAL WAR OMG!!! Yes, we all fucking know already, you don't have to preach about it twenty times a day. The federal government's role in health care is something it could potentially do for good. US history is littered with despicable, awful acts, from the legalization of slavery to the genocide of Native Americans to the wholesale slaughter of civilians in and out of wartime across the globe. To you I say so fucking what. That has nothing to do with the argument at hand and for you to bring it in just to yell at people who agree with you makes little sense. Do you honestly think that I or most of the people who follow or read you don't know what's happening with such things? Here it is you who are being condescending and belittling. Have some fucking faith in your audience.

@Dan: "multiple courts don't think the damn thing's constitutional." Two conservative courts have found it so, one has been overturned already, and the other will as well. The US has found mandates in areas such as health insurance constitutional starting in 1789. If Obamacare is struck down, so be it, and I would love to see something much better like single-payer come into play that didn't feed into insurance companies' coffers, although unfortunately with the makeup of Congress being what it is, I feel it'll be a long ass time before that can happen. But at the very least in the meantime, people with pre-existing conditions can now get some insurance like my friend with cancer.

@Todd S.: how is what I said "not-an-argument"? Just because you say it's not doesn't make it so. And what you say I meant is not what I meant. Nice try though.

@whatever: +1. That's exactly it.

@jeffbbz: "Oh geez, sorry, didn't realize you were tired of hearing about all the people we've murdered/are still being murdered by us. Man that must really be a pain in the ass for you to keep having to hear about that death and slaughter done in your name. All those families missing fathers/mothers/brothers/sisters/uncles/aunts/arms/legs/etc... really need to get over that shit already, amirite?" Yeah, you got me exactly right. Oh, I'm so fucking heartless, I don't care about anyone getting killed. Right on brah! Probably made you feel so good to try and peg someone you don't know and didn't try to understand within context as a cold bitch. Keep up your drive-by internet commentary, you're doing a bang-up job. Fuck off

I guess I've learned a big lesson today: don't try to make comments that depend on people thinking in shades of gray on political blogs, and god forbid anyone actually responding to the words written on the screen instead of some strange idea of what those words mean to whomever is reading it. I've been arguing on the internet a long time, but have never been subject to such a mindless and bizarre pile on. Thanks everyone for teaching me that I'm stupid, heartless, apathetic, an apologist for policies and presidents I despise and that I don't actually believe in everything I've been out there in the streets fighting for twenty-five years! Appreciate it!

@charles davis: a whole middle chunk of my post didn't get posted so of course I lost it. Suffice to say -

"Your comment also displays a remarkable amount of condescension and fear toward the very people I was always told the government is supposed to represent; why, if coastal elites weren't running everything, you posit, the Midwest would simply turn into a backwater of pregnant 15 year olds popping out babies to join the local white supremacist movement."

That's not what I said and it's not what I meant. You have a remarkable tendency to argue against this exaggerated idea of what people actually say. Please argue against the actual words I've written instead of your ideas of what they said.

Having said that, condescension? Hardly. It is cold hard fact that abortion under the newly passed law in Virginia has been effectively outlawed. Similar laws are being fought in Kansas and South Dakota. The rights of women and others like immigrants and minorities are being stripped state by state under the newly elected Teabaggers over the past few years. But I guess that's something that doesn't matter to you, since it doesn't affect you. Or do I have that wrong? All I have to go on is your support for Ron Paul, where it seems you ignore his anti-women and anti-immigrant stances simply because of his ideas on the war on drugs and his antiwar views as if those excuse such things. But yes, I am fearful that such laws will continue to be passed, and that health care, if left to such states, will never even come up for discussion, as has been the case until now.

There was more but whatever, it's too late and I'm done with this shit.

I agree some people have been dicks in their responses to you, for which I apologize. Personally, I wasn't trying to be a dick in my comment, though I concede I should probably include more “ :) ” in my writing. Others, though, responded to your argument with respect and citations. Several people did, actually.

Anyway, on to your latest response, where you write:

[Yglesias] didn't necessarily mean Obamacare or the mandate as it works under that.

In your original post, you wrote that Yglesias was addressing “the health care we managed to get passed,” meaning Obamacare, so I'm a bit confused at you're arguing now that he wasn't in fact talking about Obamacare and the individual mandate. It's pretty clear he was.

Your conflating what I was saying about the federal government with slavery (I mean, really?) and the war on drugs is, again, not apt.

With all due respect, you're the one that responded to my argument for reducing corporate privilege by devolving power over the health care system away from DC and returning it to states and communities by pointing to segregation and abortion and other bad things that have resulted from decentralized power in the U.S. These were two areas where you rightly pointed out that the federal government enforced a more progressive outcome than would have been the case in some states. My argument that the good that comes from that centralized power is outweighed by the much greater evils it allows – historically slavery, currently the war on drugs and the war on terror – is a direct response to that.

Counter such comments as to why the federal government would not be able to run a national health insurance plan (not the one we have currently)

I think I did in this post: the federal government is enormously susceptible to regulatory capture, and I think you'd concede that corporations more or less run the show. That's why there pharmaceutical monopolies and that's why the most progressive bill a Democratic president and a Democratic Congress could come up with was based around an individual mandate, an idea first pushed by the Heritage Foundation.

You didn't go into detail about what you meant by communities taking care of their own in your original post, so what was I left with to answer but a general idea of people taking care of people, which I think everyone can see from the state of affairs in our country today is simply not going to happen.

The entire post dealt with how I think we need more holistic reform, removing corporate privilege in the form of patent monopolies, etc., instead of the Yglesias/Obama corporatist solution, which only strengthens the corporatist nature of the health care system and the power of the insurance industry responsible for the status quo. I left you with a general idea of how states and communities could address health care because I don't there is a one-size-fits-all solution, another reason I don't support a single, nationally imposed system.

But again, your hostility to the idea of “people taking care of people” seems to be premised on the idea that people in government are any different. If we can't be trusted with taking care of our fellow human beings, if we'd just let our neighbors die without working together, the answer is to rely on politicians and the solutions _they_ come up with?

I never said that we either have corporations or a government that guarantees them a monopoly and for you to draw what I said that way is incredibly disingenuous and self-serving. I said that a federal government is an appropriate apparatus to host a health care system, which I think they should instead of private companies.

Yet, again, you argue as if the only options are 1) health care by government or 2) health care by corporation. I'm arguing that's much too limiting. And I wasn't suggesting you favor government granting lucrative monopolies to corporations, but rather that is the result we can expect from relying on the federal government for a solution to the health care crisis. And indeed, it's what we got with Obamacare.

I'm not allowed to say that Obamacare is better than nothing without being charged as a full-blown supporter who embraces everything it's about? . . . You should simply actually address the words I've written without extrapolating them into this nebulous Obama apologist argument and arguing against that instead, which is fallacious argumentation.

Look, if you want to argue Obamacare, as bad as it is, is a mild improvement over the status quo, fine. I don't agree, but it's an argument that can be made. My remark about apathy, which I didn't intend personally, is simply responding to the idea that this is the best we can do, which frankly you implied; that, like Yglesias, we should just accept the narrow range of acceptable debate in Washington and come to terms with the fact things like individual mandates are the best we can do and any broader, holistic reforms are out of the question. I don't accept that and I trust you don't either.

Maybe I was a little hyperbolic, but you argued against decentralizing power by pointing to militias and sovereign citizen movements, the implication being these people in places like Kansas and Montana – which are very different places, mind you – couldn't be trusted to govern themselves. To that I'd only note that, while you might be right in some cases, I wouldn't underestimate the people that live in the Midwest, as much as I might usually join you in mocking them. In South Dakota, for instance, the people rejected a referendum that would've banned abortion a few years back; California, meanwhile, is the state where voters banned gay marriage. Let's give credit where credit's due.

But all that aside, as I originally argued I'd rather reactionaries like George Bush and Rick Perry be stuck in the Sovereign Nation of Texas instead of empowered to govern over the whole United States -- and by extension, much of the world. Wouldn't you?

All I have to go on is your support for Ron Paul, where it seems you ignore his anti-women and anti-immigrant stances simply because of his ideas on the war on drugs and his antiwar views as if those excuse such things.

Oy. If you really want me to act like a dick I know of no surer way than to suggest I support Ron Paul. Read what I've written about the dude and I think you'll find every time I quite explicitly said “I don't support Ron Paul.” Or any politician. I believe the one line I had was about writing in “Emma Goldman.” I've written about the hypocrisy of Obama supporters, and Obama supporters only, attacking the guy for holding awful views when their guy is dropping cluster bombs and hasn't bothered to pardon one non-violent drug offender. So, c'mon. Really?

But to make a point, again, about centralized power: you say I excuse Paul's views on immigration and women (not true, but let's go with it) because I like his views on war and drugs. Couldn't the same argument be made with respect to your support for centralized power and federal supremacy? You like the good things it seems to come with, ending segregation and protecting abortion rights, but that same centralized power is what makes possible horrific things like the wars in Vietnam and Iraq -- conflicts that killed about 5 million people -- and a god awful prison system that stores 2.3 million souls, mostly poor minorities. I like Paul's views on some things, yes, but not all of them. And I don't support him. By contrast, you don't like some of the things the federal government does -- yet you support it as a whole. Unfortunately, I don't think it's possible to pick and choose what we like from centralized power.

Finally, you say states would never address health care. Well, in Massachusetts they managed to pass a bill nearly identical to Obamacare. And they beat the federal government by a number of years, for better or worse. I'm more confident states like Oregon or Washington – and again, my ideal, communities based on consensus, not coercion – could come up with more progressive solutions than the politicians and lobbyists in DC. As it stands now, those more progressive solutions are being hindered or outright forbidden by folks in Washington that would prefer to impose their own, one-size-fits-all corporatist solution, which isn't a solution at all.

And one last word about Obamacare: as you mentioned, subsidies cover some but not all of the cost of the mandate. A person making $14,000, for instance, would still be expected to pay 3 to 4 percent of their annual income, out of pocket, for insurance. That's more than $400. A lot of money. And I fear the subsidies – which are essentially direct payments to the private insurance industry – will be the first thing to go. Especially if we don't let Texas secede :)

nSquib"But at the very least in the meantime, people with pre-existing conditions can now get some insurance like my friend with cancer."Don't play that nonsense, cause you know full well that striking down the mandate doesn't mean private insurers can turn down people with pre-existing conditions, that regulatory measure still stands. They may not like the way this allows people to game the system (even though studies show people really wouldn't), but seriously, fuck them. So none of this shifty slight of hand pretending I'm standing in the way of your friend with cancer getting treatment.